Provider Demographics
NPI:1396927141
Name:PACIFIC COAST HEALTHCARE
Entity type:Organization
Organization Name:PACIFIC COAST HEALTHCARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:JOSHUA
Authorized Official - Middle Name:DANIEL
Authorized Official - Last Name:HENNIG
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:619-291-8600
Mailing Address - Street 1:4025 CAMINO DEL RIO S
Mailing Address - Street 2:SUITE #331
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92108-4107
Mailing Address - Country:US
Mailing Address - Phone:619-291-8602
Mailing Address - Fax:
Practice Address - Street 1:4025 CAMINO DEL RIO S
Practice Address - Street 2:SUITE #331
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92108-4107
Practice Address - Country:US
Practice Address - Phone:619-291-8602
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-12-04
Last Update Date:2007-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA2007026052251J00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251J00000XAgenciesNursing Care